As director of pediatric emergency medicine at Mount Sinai, Dr. Adam Vella treats patients under the age of 22 for everything from cardiac emergencies to ear infections and broken arms. Every day, as many as 10 kids come through his ER as a as a result of severe asthma attacks.

Who's at risk

Summer can be a dangerous time for children with asthma, as humidity, temperatures, air pollution and pollen counts all rise. "Asthma is an allergy specific to the lungs, where the airways are hyper-reactive and respond to allergens by shutting down," says Vella. "Though millions of adults have asthma, too, it's even more common in kids, many of whom will grow out of it."

About one in 10 American children is living with asthma. "It's a genetic predisposition that responds to an environmental trigger," says Vella. "For these kids, an asthma attack can be triggered by a simple cold or an airborne allergen like pollen."

The long list of common triggers includes viral infections, dust, pollen, cockroaches, animals and house pets, pollution and changes in the weather.

Anyone can have an asthma attack, but kids with chronic asthma end up in the ER or doctor's office again and again.

"Generally it's kids with a genetic predisposition who end up with chronic asthma, also called reactive airway disease," says Vella. "In the past 10 years, asthma is just getting more and more common — and so far, we don't know why."

Certain groups are at higher risk of developing asthma than others.

"Asthma is more common in kids who were preemies, kids with reflux and kids with heart conditions," says Vella. "But the biggest chunk of kids just have a genetic predisposition." Children living in inner cities are at higher risk of severe asthma because their environment is full of triggers like pollution, cockroaches and fungus.

Signs and symptoms

Asthma is easy to identify once you know the signs. "The classic symptoms are shortness of breath with coughing, trouble catching breath, and fast breathing," says Vella. "As opposed to a cold, which causes nasal congestion and cough, asthma is lower down in the lungs, so we can hear wheezing in the cough or when they breathe out."

It's important to take any trouble with breathing seriously.

"For a mom or dad at home, if it seems like your child is having difficulty breathing, don't blow that off," says Vella. "Once they start breathing faster than normal or they have trouble breathing, you should get on the phone with the pediatrician."

A trip to the ER may be necessary.

Fever on its own can also cause fast breathing, so treat the fever first and breathing should go back to normal.

Traditional treatment

Preventing asthma attacks from happening is the first line of defense.

"Reducing your kid's exposure to allergens is a key first step," says Vella. "That can be as simple as not letting them play on the grass right after it's been mown or not staying with relatives who smoke or have a pet."

Other allergens — like pollution, pollen and dust — may be impossible to avoid, but you can minimize exposure by taking steps like getting an indoor air filter and cleaning the filter on your air conditioner.

While no one can avoid all allergens, the current generation of drugs offers many ways of managing the disease. "For most kids, medicine is taken when they feel the onset of an attack," says Vella.

"They start to feel shortness of breath and take two puffs on their inhaler." The most common of these broncho-dilators is albuterol, which is often taken as two puffs every four hours.

The sooner your child takes medication, the better."

As the attack goes on untreated, it gets harder to reverse," says Vella. "When kids come in with bad outcomes, it's usually because the parents delayed care."

Acute emergencies can lead to hospitalization and the insertion of a breathing tube. In the worst cases, asthma attacks can be fatal.

For kids at higher risk, low-dose steroids are an option as a controller medication and can cut down on the number of attacks.

"Not every kid with asthma needs an inhaled steroid, but a kid who is coming into the ER frequently should be on it," says Vella.

"There used to be some controversy about whether inhaled steroids stunt growth, but the studies have found these kids may grow slower for a few years, but then they catch up."

The good news for parents is that most kids will outgrow asthma.

"We can't tell which kids will outgrow it and which won't, but parents and doctors can work together to manage this disease," says Vella.

Research breakthroughs

Since millions of Americans are living with asthma — and cases are on the rise — there is booming research on providing better treatment. "There are a lot of new medications out there, including anti-inflammatories like Singulair," says Vella. "It's for kids who don't quite make the cut to go on an inhaled steroid, but could benefit from an alternative controller therapy."

Questions for your doctor

Parents need to take steps to learn how to take care of asthmatic children. Be sure to ask, "How can I recognize a significant asthma attack?" and "What's the first thing I should do when my child has an asthma attack?"

Medications are constantly changing, so ask "What medications are available for my child?" Even if you or your older children were treated for asthma with certain drugs, there probably is a better option for your child today.